Provider Demographics
NPI:1932309911
Name:HARTMAN, JUSTIN GARETT (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GARETT
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BRUCE ST
Mailing Address - Street 2:AVERA MARSHALL
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1934
Mailing Address - Country:US
Mailing Address - Phone:507-532-9661
Mailing Address - Fax:507-537-9043
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:AVERA MARSHALL
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-532-9661
Practice Address - Fax:507-537-9043
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55075208M00000X
PAOS014607207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA181698Medicare PIN
PA1024349240001Medicaid